Teens Drink, Smoke Less in 'Caring' Communities

Action Points

Explain that a program that enables communities to tailor risky behavior prevention strategies can lead to lasting reductions in substance use and delinquency among adolescents.

Note that prevalence rates of binge drinking in the past two weeks, past-month alcohol, smokeless tobacco, marijuana, and other illicit drug use among 10th graders didn't differ significantly between groups, although the program significantly reduced the incidence of alcohol and cigarette use by grade 10.

A program that enables communities to tailor risky behavior prevention strategies can lead to lasting reductions in substance use and delinquency among adolescents, researchers found.

The overall increase in targeted risk between grades 5 and 10 was significantly smaller for places that implemented the "Communities That Care" program, even a year after the program was halted (P<0.05), J. David Hawkins, PhD, of the University of Washington, and colleagues reported online in the Archives of Pediatrics and Adolescent Medicine.

"The use of [the program] did not eliminate these adolescent problem behaviors in participating communities, but it reduced them significantly," they wrote.

The objective of Communities That Care is to increase the proportion of social policy decisions that are evidence-based. It enables community leaders to pick their own preventive interventions to address their community's unique profile of risk, Hawkins and colleagues explained.

Programs chosen by the communities varied widely, from early childhood interventions and community alcohol policies to school curricula that teach skills for handling emotional and social problems.

The first randomized trial of the program found that after four years, the incidence of delinquency, alcohol use, cigarette use, and smokeless tobacco was significantly lower for communities that implemented the program than for control communities.

Since the program has now been placed in the public domain by the Substance Abuse and Mental Health Services Administration (SAMHSA) and thus has the potential for widespread dissemination, the researchers said it is important to understand the potential for sustained outcome benefits after the program ends.

So to test whether the benefits held six years after implementation and one year after resources ended, Hawkins and colleagues looked at data from the Community Youth Development Study, the first community randomized trial of Communities That Care.

A total of 24 small towns in seven states participated, yielding data on 4,407 fifth-grade students who were surveyed annually through grade 10, from 2004 to 2009.

The researchers found that the overall increase in targeted risk behaviors between grades 5 and 10 was significantly smaller in communities that had implemented the program than in those without (P<0.05).

As well, by grade 10, mean levels of targeted risks were significantly lower for program communities than controls, they reported.

The program also significantly reduced the incidence of alcohol and cigarette use by grade 10, as students in program communities had a 38% lower odds of starting alcohol use than those in control communities (P=0.03).

They were also 46% less likely to start smoking in grade 10 than control students (P=0.006).

And the likelihood of initiating delinquent behavior by grade 10 was 21% lower for those in Communities That Care programs, the researchers said (P=0.03).

However, prevalence rates of binge drinking in the past two weeks, past-month alcohol, smokeless tobacco, marijuana, and other illicit drug use among 10th graders didn't differ significantly between groups.

"It is possible that effects on the use of these drugs may be observed later as their use becomes more prevalent in the adolescent population," the researchers wrote.

And although the prevalence of delinquent and violent behaviors was significantly lower overall for communities that implemented the program (AOR 0.83, P=0.04 and AOR 0.75, P=0.03, respectively), the variety of delinquent or violent acts wasn't lower among these communities.

Still, they concluded that the findings "indicate that use of Communities That Care can contribute to long-term community-wide improvements in public health."

The study was supported by the National Institute on Drug Abuse and other departments of the National Institutes of Health.

A co-author reported relationships with Channing Bete Company, which distributes some programs that were used in some communities in the study.

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